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General NPI Number Information
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NPI Number | 1760865562
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Entity Type | Individual
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Provider Name | ALYSSA DEMATTEO LMSW
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Gender | Female
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Dates
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Enumeration Date | 06/30/2015
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Last Update Date | 04/09/2025
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Provider Practice Location Address
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Address Line | 77 GOODELL ST
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City | BUFFALO
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State | NY
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Zip | 14203-1243
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Country | US
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Telephone | --
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Fax |
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Provider Business Mailing Address
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Address Line | 5 CLARA DR
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City | NORWALK
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State | CT
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Zip | 06851-3203
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Country | US
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Telephone | 203-246-3378
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 4788
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 011579
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License Number State | CT
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